© 1995 by European Society of Cardiology
Copyright © 1995, European Society of Cardiology
The effects of exogenous nitric oxide on smooth muscle cell proliferation following porcine carotid angioplasty
aDepartment of Cardiology, University of Wales College of Medicine, Heath Park, Cardiff CF4 4XN, UK
bDepartment of Pharmacology and Therapeutics, University of Wales College of Medicine, Heath Park, Cardiff CF4 4XN, UK
* Corresponding author: Department of Cardiology, Royal Brompton National Heart and Lung Hospital, Sydney St, London SW3 6NP, UK Tel. 071 3528121; Fax: 071 3528629.
Objectives: Nitric oxide reduces platelet adhesion and platelet-thrombus formation following angioplasty and inhibits smooth muscle cell (SMC) proliferation in vitro. In this study we investigated the effects of the nitric oxide donor molsidomine on SMC proliferation and intimal growth following experimental angioplasty. Methods: Bilateral carotid angioplasty was performed in 24 anesthetized pigs. Animals were randomized to receive oral molsidomine (whose active metabolite is SIN-1; 0.3 mg/kg every 8 h; n = 12) or placebo (n = 12) for 48 h before angioplasty and until the arteries were removed either 7 or 21 days (n = 12 each group) later. SMC proliferation was quantified by immunocytochemical staining with an antibody to the proliferating cell nuclear antigen (PCNA) and morphometric changes by computerized planimetry. SMC's were identified by 
-actin staining. Results: After 3 weeks treatment with molsidomine there was a significant prolongation in bleeding time [mean ± SEM](151 ± 6 to 187 ± 7 s. P < 0.01) and a sustained increase in arterial wall cyclic GMP (6.57 ± 1.29 to 13.24 ± 1.02 pmol/mg protein, P < 0.05). Molsidomine significantly reduced intimal proliferation when compared with placebo in arteries with an intact internal elastic lamina at 7 days (4.3 ± 0.7 vs. 9.6 ± 1.9 PCNA index, P < 0.005) and medial proliferation at 7 days (2.4 ± 0.2 vs. 4.2 ± 0.7 PCNA index, P < 0.05) and at 21 days (1.3 ± 0.1 vs. 1.9 ± 0.2 PCNA index, P < 0.05) after angioplasty. In arteries with rupture of the internal elastic lamina, intimal and medial SMC proliferation were similar in molsidomine- and placebo-treated animals. Intimal cell number and intimal area were uninfluenced by treatment with molsidomine in either the presence or absence of rupture of the internal elastic lamina. Conclusions: These results show for the first time that exogenous nitric oxide inhibits SMC proliferation following balloon angioplasty in vivo. The antiproliferative effects of nitric oxide are overwhelmed when injury is severe and are not associated with a reduction in intimal thickening. The inhibitory effects of nitric oxide on platelet adhesion and SMC proliferation identify a possible role for high local concentrations of nitric oxide to modify the vascular response to balloon angioplasty.
KEYWORDS Restenosis; SIN-1; Platelets; Molsidomine; Smooth muscle cell proliferation; Pig, arteries
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